K. Stuart Lee

Surgical repair of aneurysms of the posterior inferior cerebellar artery—A clinical series☆

Aneurysms of the posterior inferior cerebellar artery are relatively rare. Fourteen such aneurysms (10 vertebral, 4 peripheral) are reported, and their clinical presentation, surgical therapy, and outcome are discussed. All 14 patients had suffered a subarachnoid hemorrhage; 93% (n = 13) underwent direct clipping of the aneurysm while 7% (n = 1) underwent coating of the aneurysm. Two patients died in the perioperative period (one from vasospasm and one from rebleeding). Full activity was achieved by all but one (92%) of the remaining patients in extended follow-up.

Spinal epidural hematoma associated with Paget's disease

Although increased skeletal blood flow in the bone involved by Pagets disease is well described, spinal hemorrhage in association with that disease has not previously been reported. We report a patient with Pagets disease of bone who developed a subacute epidural hematoma of the lumbar spine.

Schwannoma of the facial nerve in the cerebellopontine angle presenting with hearing loss

Schwannomas of the facial nerve in the cerebellopontine angle are unusual. The authors describe a 43-year-old woman with progressive hearing loss and dizziness who had a small schwannoma of the facial nerve in the cerebellopontine angle without extension into the internal auditory canal. The tumor was completely removed with preservation of facial nerve function. The diagnosis and management of facial nerve schwannomas are discussed.

Oculomotor palsy with pupillary sparing in a patient with chronic subdural hematoma

A patient with adult-onset diabetes mellitus developed an oculomotor palsy with pupillary sparing. Five days after her initial evaluation, she presented in a confused state with a complete oculomotor palsy. Computed cranial tomography revealed a chronic subdural hematoma. We recommend that noninvasive radiographic intracranial investigation be considered in elderly patients with adult-onset diabetes mellitus who present with headache and pupil-sparing oculomotor palsy.

Stroke, myocardial infarction, and survival during long-term follow-up after carotid endarterectomy

Epidemiological data on 211 patients undergoing 256 carotid endarterectomies were reviewed, and current data for the 205 perioperative survivors were analyzed by the actuarial method. The median follow-up period was 7.0 years (range: 1 month to 23.2 years). Seven percent of patients were lost to follow-up. Actuarial survival was 77% (5 years) and 49% (10 years), but lower than for the general population. Late stroke occurred in 27 patients (13%) (fatal in 9), being ipsilateral to an endarterectomy in only 10 (4.9%). The annual ipsilateral stroke rate (0.41%), comparable to that of the general population, suggests protection from subsequent stroke. Myocardial infarction occurred in 69 patients (34%), and accounted for 49% of late deaths.

Superior sagittal sinus air after penetrating craniocerebral trauma

Intracranial air secondary to craniocerebral trauma is not uncommon. Computed tomography scanning may show the air within specific intracranial compartments. We report a case of air within the superior sagittal sinus visualized with computed tomography and documented at operation.